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See detailDecentralisation and community engagement for better mental health services development in the conflict-affected regions of Ukraine
Klymchuk, Vitalii UL; Vysotska, Krystyna; Gorbunova, Viktoriia

in Journal of Public Mental Health (2022)

<h4>Purpose: </h4> The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The ... [more ▼]

<h4>Purpose: </h4> The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on communities' perception of their problems and solutions that communities can create to achieve better mental health coverage. <h4>Design: </h4> /methodology/approach Series of roundtables (4 roundtables, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities' representatives from the East of Ukraine (Lugansk region, government-controlled area). Participants were provided with the opportunity to discuss mental health services development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered to review by participants. <h4>Findings: </h4> Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Rising-awareness interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination, and collaboration problems; infrastructure, physical accessibility, and financial problems; mental health and primary healthcare workforce shortage and lack of competencies; low awareness in mental health, available services, and high stigma; war, crises, and pandemic-related problems. Communities foresaw seven domains of actions: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative, healthcare); mental health advocacy and lobby lead by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing of services by combining efforts and budgets of neighbouring communities. Originality The paper is original in terms of its topic (connecting decentralisation and community engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context). [less ▲]

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See detailApplying the national mental health policy in conflict-affected regions: towards better social inclusion (Ukrainian case)
Quirke, Eleanor; Klymchuk, Vitalii UL; Gusak, Nataliia et al

in Mental Health and Social Inclusion (2022), 26(3 2022-06-29T00:00:00), 242-256

Purpose The ongoing armed conflict in Ukraine has had wide-ranging health, social and economic consequences for the civilian population. It has emphasised the need for comprehensive and sustainable reform ... [more ▼]

Purpose The ongoing armed conflict in Ukraine has had wide-ranging health, social and economic consequences for the civilian population. It has emphasised the need for comprehensive and sustainable reform of the Ukrainian mental health system. The Ukrainian Government has approved a vision for national mental health reform. This study aims to draw on the lessons of mental health reform in other conflict-affected settings to identify areas of priority for applying the national mental health policy in conflict-affected regions in the direction of better social inclusion of people with mental health conditions (Donetsk and Luhansk regions, directly affected by the conflict). Design/methodology/approach A literature review was conducted to identify lessons from implementing mental health reform in other conflict-affected settings. Findings were summarized, and best practices were applied to the national and regional policy context. Findings The literature described emergencies as an opportunity to build sustainable mental health systems. A systematic and long-term view for reform is required to capitalise on this opportunity. For better social inclusion, implementation of the concept for mental health and mental health action plans in Donetsk and Luhansk regions should prioritise raising mental health awareness and reducing stigma; developing the capacity of local authorities in the development and coordination of services; tailoring mental health service provision according to the availability of services and population need targeting the needs of particularly vulnerable groups and embedding the activities of humanitarian actors in local care pathways. Research limitations/implications This study summarises the literature on mental health reform in conflict-affected settings and applies key findings to Eastern Ukraine. This study has drawn on various sources, including peer-reviewed journals and grey literature and made several practical recommendations. Nevertheless, potentially relevant information could have been contained in sources that were excluded based on their publication in another language (i.e. not in English). Indeed, while the included studies provided rich examples of mental health reform implemented in conflict-affected settings, further research is required to better understand the mechanisms for effecting sustainable mental health reform in conflict-affected settings Originality/value The paper describes opportunities for developing a local community-based mental health-care system in Ukraine, despite the devastating effects of the ongoing war. [less ▲]

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